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Cent Eur Neurosurg 2002; 63(2): 70-76
DOI: 10.1055/s-2002-33972
Therapie-Konsensus

© Johann Ambrosius Barth

Empfehlungen zum Management nichtrupturierter intrakranieller Aneurysmen

Recommendations for the management of unruptured intracranial aneurysmsA. Raabe1 , V. Seifert1 , P. Schmiedek2 , H. Steinmetz3 , H. Bertalanffy4 , H.-J. Steiger5 , D. Stolke6 , M. Forsting7
  • 1 Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität Frankfurt am Main
  • 2 Neurochirurgische Klinik, Klinikum der Stadt Mannheim
  • 3 Klinik und Poliklinik für Neurologie, Johann Wolfgang Goethe-Universität Frankfurt am Main
  • 4 Neurochirurgische Klinik, Klinikum der Universität Marburg
  • 5 Neurochirurgische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • 6 Neurochirurgische Klinik, Universitätsklinikum der Gesamthochschule Essen
  • 7 Neuroradiologie, Universitätsklinikum der Gesamthochschule Essen, Sektion Vaskuläre Neurochirurgie der Deutschen Gesellschaft für Neurochirurgie
Further Information

Publication History

Publication Date:
11 September 2002 (online)

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Zusammenfassung:

Das optimale Management von Patienten mit nichtrupturierten intrakraniellen Aneurysmen wird kontrovers diskutiert. Durch die Veröffentlichung neuer Studien in den letzten Jahren ist eine erhebliche Unsicherheit über das optimale Management von Patienten mit nichtrupturierten Aneurysmen entstanden. Die Sektion Vaskuläre Neurochirurgie der Deutschen Gesellschaft für Neurochirurgie hat eine interdisziplinäre Arbeitsgruppe gebildet, die in Anlehnung an die American Heart Association (AHA) eine Zusammenfassung der existierenden Daten vornehmen und Empfehlungen aussprechen soll. Entsprechend den von der AHA benutzten Kriterien sind die existierenden Daten zum natürlichen Verlauf eines nichtrupturierten Aneurysmas einschließlich der aktuell publizierten Arbeiten hinsichtlich ihres Gewichtes lediglich dem Level IV-V zuzuordnen (historische Kohortenvergleiche oder retrospektive Fallserien). Damit unterstützt die Datenlage Vorschläge zum Management (“Grad C-Empfehlung” der AHA), aber keine Standards und keine Richtlinien. Die vorliegenden Empfehlungen sind im interdisziplinären neuromedizinischen Konsens entstanden und berücksichtigen die aktuellen Daten zum natürlichen Verlauf der nichtrupturierten Aneurysmen und die Risiken der einzelnen Behandlungsverfahren.

Summary

Optimal management of patients with unruptured intracranial aneurysms (UIAs) remains controversial. Recent studies have found conflicting data regarding the natural history and the treatment outcome of UIAs. Based on the recommendations published by the American Heart Association, the Section of Vascular Neurosurgery of the German Society of Neurosurgery has formed a task force to summarize the available data and to develop a practical framework for the management of UIAs. For UIAs, only evidence from nonrandomized historical cohort comparisons and case series without control subjects are available, supporting only grade C recommendations (options), but no standards (grade A) and no guidelines (grade B). The present recommendations have been developed as a neurosurgical, neuroradiological and neurological consensus. They are based on the existing data of both treatment risks and the risks of the natural history of UIAs.

Schlüsselwörter

Nichtrupturiertes Aneurysma - Aneurysma - Therapie

Key words:

Unruptured intracranial aneurysm - Natural history - Management - Outcome

Literatur

  • 1 Hop J W, Rinkel G J, Algra A, van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review.  Stroke. 1997;  28 660-664
    CrossrefPubMedSearch in Google Scholar
  • 2 Bederson J B, Awad I A, Wiebers D O, Piepgras D, Haley E C, Brott T, Hademenos G, Chyatte D, Rosenwasser R, Caroselli C. Recommendations for the management of patients with unruptured intracranial aneurysms: A Statement for healthcare professionals from the Stroke Council of the American Heart Association.  Stroke. 2000;  31 2742-2750
    CrossrefPubMedSearch in Google Scholar
  • 3 Whisnant J P, Sacco S E, O'Fallon W M, Fode N C, Sundt T M. Referral bias in aneurysmal subarachnoid hemorrhage.  J.Neurosurg.. 1993;  78 726-732
    PubMedSearch in Google Scholar
  • 4 Torner J C, Davis P H. Epidemiology and clinical manifestations of subarachnoid hemorrhage. Bederson, J. B. Subarachnoid hemorrhage: pathophysiology and management. Park Ridge, American Association of Neurological Surgeons. 1997: 1-26
    Search in Google Scholar
  • 5 Hop J W, Rinkel G J, Algra A, van Gijn J. Quality of life in patients and partners after aneurysmal subarachnoid hemorrhage.  Stroke. 1998;  29 798-804
    PubMedSearch in Google Scholar
  • 6 Hutter B , Gilsbach J M. Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage?.  Neurosurgery. 1993;  33 999-1005
    CrossrefPubMedSearch in Google Scholar
  • 7 Winn H R, Almaani W S, Berga S L, Jane J A, Richardson A E. The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms.  J.Neurosurg.. 1983;  59 642-651
    PubMedSearch in Google Scholar
  • 8 International Study of Unruptured Intracranial Aneurysms Investigators. . Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention.  N. Engl. J. Med.. 1998;  339 1725-1733
    CrossrefPubMedSearch in Google Scholar
  • 9 Heiskanen O. Risk of bleeding from unruptured aneurysm in cases with multiple intracranial aneurysms.  J. Neurosurg.. 1981;  55 524-526
    PubMedSearch in Google Scholar
  • 10 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture.  J. Neurosurg.. 2000;  93 379-387
    CrossrefPubMedSearch in Google Scholar
  • 11 Tsutsumi K, Ueki K, Morita A, Kirino T. Risk of rupture from incidental cerebral aneurysms.  J. Neurosurg.. 2000;  93 550-553
    PubMedSearch in Google Scholar
  • 12 Juvela S, Porras M, Heiskanen O. Natural history of unruptured intracranial aneurysms: a long-term follow-up study.  J. Neurosurg.. 1993;  79 174-182
    Search in Google Scholar
  • 13 Graf C J. Prognosis for patients with nonsurgically-treated aneurysms. Analysis of the Cooperative Study of Intracranial Aneurysms and Subarachnoid hemorrhage.  J. Neurosurg.. 1971;  35 438-443
    PubMedSearch in Google Scholar
  • 14 Inagawa T, Hada H, Katoh H. Unruptured intracranial aneurysms in elderly patients.  Surg. Neurol.. 1992;  38 364-370
    PubMedSearch in Google Scholar
  • 15 Asari S, Ohmoto T. Natural history and risk factors of unruptured cerebral aneurysms.  Clin. Neurol. Neurosurg.. 1993;  95 205-214
    PubMedSearch in Google Scholar
  • 16 Yasui N, Suzuki A, Nishimura H, Suzuki K, Abe T. Long-term follow-up study of unruptured intracranial aneurysms.  Neurosurgery. 1997;  40 1155-1159
    PubMedSearch in Google Scholar
  • 17 Wiebers D O, Whisnant J P, Sundt T M, O'Fallon W M. The significance of unruptured intracranial saccular aneurysms.  J. Neurosurg.. 1987;  66 23-29
    CrossrefPubMedSearch in Google Scholar
  • 18 Rinkel G J, Djibuti M, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review.  Stroke. 1998;  29 251-256
    CrossrefPubMedSearch in Google Scholar
  • 19 Yasui N, Magarisawa S, Suzuki A, Nishimura H, Okudera T, Abe T. Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases.  Neurosurgery. 1996;  39 1096-1100
    PubMedSearch in Google Scholar
  • 20 Mizoi K, Yoshimoto T, Nagamine Y, Kayama T, Koshu K. How to treat incidental cerebral aneurysms: a review of 139 consecutive cases.  Surg. Neurol.. 1995;  44 114-120
    PubMedSearch in Google Scholar
  • 21 Orz Y, Kobayashi S, Osawa M, Tanaka Y. Aneurysm size: a prognostic factor for rupture.  Br. J. Neurosurg.. 1997;  11 144-149
    CrossrefPubMedSearch in Google Scholar
  • 22 Sampei T, Mizuno M, Nakajima S, Suzuki A, Hadeishi H, Ishikawa T, Yasui N. [Clinical study of growing up aneurysms: report of 25 cases].  No Shinkei Geka. 1991;  19 825-830
    PubMedSearch in Google Scholar
  • 23 Hademenos G J, Massoud T F, Turjman F, Sayre J W. Anatomical and morphological factors correlating with rupture of intracranial aneurysms in patients referred for endovascular treatment.  Neuroradiology. 1998;  40 755-760
    CrossrefPubMedSearch in Google Scholar
  • 24 Crompton M R. Mechanism of growth and rupture in cerebral berry aneurysms.  Br. Med. J.. 1966;  5496 1138-1142
    PubMedSearch in Google Scholar
  • 25 Allcock J M, Canham P B. Angiographic study of the growth of intracranial aneurysms.  J. Neurosurg.. 1976;  45 617-621
    PubMedSearch in Google Scholar
  • 26 Sarti C, Tuomilehto J, Salomaa V, Sivenius J, Kaarsalo E, Narva E V, Salmi K, Torppa J. Epidemiology of subarachnoid hemorrhage in Finland from 1983 to 1985.  Stroke. 1991;  22 848-853
    PubMedSearch in Google Scholar
  • 27 Ronkainen A, Hernesniemi J, Puranen M, Niemitukia L, Vanninen R, Ryynanen M, Kuivaniemi H, Tromp G. Familial intracranial aneurysms.  Lancet. 1997;  349 380-384
    CrossrefPubMedSearch in Google Scholar
  • 28 Raaymakers T W, Rinkel G J, Ramos L M. Initial and follow-up screening for aneurysms in families with familial subarachnoid hemorrhage.  Neurology. 1998;  51 1125-1130
    PubMedSearch in Google Scholar
  • 29 Schievink W I. Genetics of intracranial aneurysms.  Neurosurgery. 1997;  40 651-662
    CrossrefPubMedSearch in Google Scholar
  • 30 The Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group. . Risks and benefits of screening for intracranial aneurysms in first- degree relatives of patients with sporadic subarachnoid hemorrhage.  N. Engl. J. Med.. 1999;  341 1344-1350
    CrossrefPubMedSearch in Google Scholar
  • 31 David C A, Vishteh A G, Spetzler R F, Lemole M, Lawton M T, Partovi S. Late angiographic follow-up review of surgically treated aneurysms.  J. Neurosurg.. 1999;  91 396-401
    CrossrefPubMedSearch in Google Scholar
  • 32 Tsutsumi K, Ueki K, Morita A, Usui M, Kirino T. Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography.  Stroke. 2001;  32 1191-1194
    CrossrefPubMedSearch in Google Scholar
  • 33 Teunissen L L, Rinkel G J, Algra A, van Gijn J. Risk factors for subarachnoid hemorrhage: a systematic review.  Stroke. 1996;  27 544-549
    CrossrefPubMedSearch in Google Scholar
  • 34 Ingall T J, Whisnant J P, Wiebers D O, O'Fallon M W. Has there been a decline in subarachnoid hemorrhage mortality?.  Stroke. 1989;  20 718-724
    CrossrefPubMedSearch in Google Scholar
  • 35 Linn F H, Rinkel G J, Algra A, van Gijn J. Incidence of subarachnoid hemorrhage: role of region, year, and rate of computed tomography: a meta-analysis.  Stroke. 1996;  27 625-629
    CrossrefPubMedSearch in Google Scholar
  • 36 Weir b. Unruptured intracranial aneurysms: a review.  J. Neurosurg.. 2002;  96 3-42
    PubMedSearch in Google Scholar
  • 37 Winn H R, Jane J A, Taylor J, Kaiser D, Britz G W. Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms.  J. Neurosurg.. 2002;  96 43-49
    CrossrefPubMedSearch in Google Scholar
  • 38 Tsutsumi K, Ueki K, Usui M, Kwak S, Kirino T. Risk of subarachnoid hemorrhage after surgical treatment of unruptured cerebral aneurysms.  Stroke. 1999;  30 1181-1184
    PubMedSearch in Google Scholar
  • 39 Feuerberg I, Lindquist C, Lindqvist M, Steiner L. Natural history of postoperative aneurysm rests.  J. Neurosurg.. 1987;  66 30-34
    CrossrefPubMedSearch in Google Scholar
  • 40 Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils.  Radiology. 1999;  212 348-356
    PubMedSearch in Google Scholar
  • 41 Uda K, Murayama Y, Gobin Y P, Duckwiler G R, Vinuela F. Endovascular treatment of basilar artery trunk aneurysms with Guglielmi detachable coils: clinical experience with 41 aneurysms in 39 patients.  J. Neurosurg.. 2001;  95 624-632
    CrossrefPubMedSearch in Google Scholar
  • 42 Hayakawa M, Murayama Y, Duckwiler G R, Gobin Y P, Guglielmi G, Vinuela F. Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system.  J. Neurosurg.. 2000;  93 561-568
    PubMedSearch in Google Scholar
  • 43 Byrne J V, Sohn M J, Molyneux A J, Chir B. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding.  J. Neurosurg.. 1999;  90 656-663
    CrossrefPubMedSearch in Google Scholar
  • 44 Kuether T A, Nesbit G M, Barnwell S L. Clinical and angiographic outcomes, with treatment data, for patients with cerebral aneurysms treated with Guglielmi detachable coils: a single-center experience.  Neurosurgery. 1998;  43 1016-1025
    CrossrefPubMedSearch in Google Scholar
  • 45 Raaymakers T W. Functional outcome and quality of life after angiography and operation for unruptured intracranial aneurysms. On behalf of the MARS Study Group.  J. Neurol. Neurosurg. Psychiatry. 2000;  68 571-576
    CrossrefPubMedSearch in Google Scholar
  • 46 Raaymakers T W, Rinkel G J, Limburg M, Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis.  Stroke. 1998;  29 1531-1538
    CrossrefPubMedSearch in Google Scholar
  • 47 Brilstra E H, Rinkel G J, van der G Y, van Rooij W J, Algra A. Treatment of intracranial aneurysms by embolization with coils: a systematic review.  Stroke. 1999;  30 470-476
    CrossrefPubMedSearch in Google Scholar
  • 48 Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms.  Stroke. 2001;  32 1998-2004
    CrossrefPubMedSearch in Google Scholar
  • 49 Cloft H J, Joseph G J, Dion J E. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis.  Stroke. 1999;  30 317-320
    CrossrefPubMedSearch in Google Scholar

PD Dr. Andreas Raabe

Neurochirurgische Klinik und Poliklinik

Schleusenweg 2-16

60528 Frankfurt am Main

Phone: 069 6301 5939

Fax: 069 6301 7175

Email: A.Raabe@em.uni-frankfurt.de